AustralieFrV1, Main, Exploration, bibRecord, 006D04

Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi

Identifieur interne : 006D04 ( Main/Exploration ); précédent : 006D03; suivant : 006D05

Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi

Auteurs : Rupa Kanapathipillai [Malawi, Australie] ; Megan Mcguire [France] ; Robert Mogha [Malawi] ; Elisabeth Szumilin [France] ; Annette Heinzelmann [France] ; Mar Pujades-Rodriguez [France]

Source :

TM & IH. Tropical medicine & international health [ 1360-2276 ] ; 2011.

RBID : Pascal:11-0504115

Descripteurs français

Pascal (Inist)
- SIDA, Antiviral, Charge virale, Echec, Traitement, Virus immunodéficience humaine, Milieu rural, Malawi, Antirétroviral, Médecine tropicale.
Wicri :
- geographic : Malawi.

English descriptors

KwdEn :
- AIDS, Antiretroviral agent, Antiviral, Failure, Human immunodeficiency virus, Malawi, Rural environment, Treatment, Tropical medicine, Viral load.

Abstract

OBJECTIVE Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. METHODS Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. RESULTS Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41 % of patients initially diagnosed with immunological failure did no longer meet failure criteria. CONCLUSIONS Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.

Affiliations:

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Le document en format XML

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Antiretroviral agent</term>
<term>Antiviral</term>
<term>Failure</term>
<term>Human immunodeficiency virus</term>
<term>Malawi</term>
<term>Rural environment</term>
<term>Treatment</term>
<term>Tropical medicine</term>
<term>Viral load</term>
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<term>Antiviral</term>
<term>Charge virale</term>
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<term>Traitement</term>
<term>Virus immunodéficience humaine</term>
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<term>Malawi</term>
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<front><div type="abstract" xml:lang="en">OBJECTIVE Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. METHODS Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. RESULTS Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41 % of patients initially diagnosed with immunological failure did no longer meet failure criteria. CONCLUSIONS Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries.</div>
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<country name="France"><region name="Île-de-France"><name sortKey="Mcguire, Megan" sort="Mcguire, Megan" uniqKey="Mcguire M" first="Megan" last="Mcguire">Megan Mcguire</name>
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<name sortKey="Heinzelmann, Annette" sort="Heinzelmann, Annette" uniqKey="Heinzelmann A" first="Annette" last="Heinzelmann">Annette Heinzelmann</name>
<name sortKey="Pujades Rodriguez, Mar" sort="Pujades Rodriguez, Mar" uniqKey="Pujades Rodriguez M" first="Mar" last="Pujades-Rodriguez">Mar Pujades-Rodriguez</name>
<name sortKey="Szumilin, Elisabeth" sort="Szumilin, Elisabeth" uniqKey="Szumilin E" first="Elisabeth" last="Szumilin">Elisabeth Szumilin</name>
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Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi

Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri